Psychometric properties of the Norwegian self-efficacy for therapeutic mode use (N-SETMU)

Abstract

Background: According to the Intentional Relationship Model (IRM), the intentional use of relational approaches in therapy (therapeutic modes) is essential for obtaining successful relationships to clients. There have been no attempts to combine the IRM with self-efficacy theory, and instruments for measuring self-efficacy for therapeutic mode use are lacking.

Aim: This study aimed to examine the component structure and internal consistency of the Norwegian version of the Self-Efficacy for Therapeutic Mode Use (N-SETMU).

Methods: Occupational therapy students (n?=?111) from two education programs completed the N-SETMU along with sociodemographic information. Principal Components Analysis (PCA) was performed and component extraction was controlled using Parallel Analysis. Internal consistency was assessed with Cronbach’s α and inter-item correlations.

Results: All items on the N-SETMU loaded on the same latent dimension, tentatively called Self-Efficacy for Therapeutic Mode Use. Cronbach’s α for the scale was 0.82.

Conclusions: The N-SETMU is a unidimensional measure of self-efficacy for therapeutic mode use in general. The N-SETMU may be a useful tool for occupational therapy research and audits focusing on occupational therapists’ use of therapeutic modes in client interactions.     

Approaches to learning among occupational therapy undergraduate students: A cross-cultural study

Background: Students may adopt various approaches to academic learning. Occupational therapy students’ approaches to study and the impact of cultural context have not been formally investigated to date.

Aim: To examine the approaches to study adopted by undergraduate occupational therapy students from four different cultural settings.

Method: 712 undergraduate occupational therapy students (n?=?376 from Australia, n?=?109 from Hong Kong, n?=?160 from Norway and n?=?67 from Singapore) completed the Approaches and Study Skills Inventory for Students (ASSIST). A one-way analysis of variance (ANOVA) was conducted to compare the ASSIST subscales for the students from the four countries.

Results: Post-hoc comparisons using the Tukey HSD test indicated that the mean scores for the strategic approach were significantly different between Australia and the other three countries. The mean scores for the surface approach were significantly different between Australia and Hong Kong, and Hong Kong and Norway. There were no significant differences between the deep approach to studying between Australia, Norway, Singapore and Hong Kong.

Conclusion &; implications: Culture and educational context do appear to impact the approaches to study adopted by undergraduate occupational therapy students. Academic and practice educators need to be cognizant of what approaches to studying the students they work with adopt.     

Relationships between occupational therapy students’ understandings of disability and disability attitudes

Abstract

Background: Entering occupational therapy (OT) students have established beliefs, informed by sociocultural backgrounds. Understanding how students define and understand disability, and the relationships these understandings have to disability bias, can guide curriculum design decisions to integrate meso and macro level perspectives of disability into clinical reasoning.

Aim/Objective: This study’s aim was to explore incoming occupational therapy students’ (n?=?67) understandings of disability and their attitudes towards it.

Material and method: An online survey was used to collect data on students’ attitudes and definitions of disability. Mixed research methods were used to analyze students’ definitions of disability (content analysis) in relation to disability attitudes (Disability Attitudes Implicit Association Test).

Results/Finding: Findings reveal students enter curriculums with vast differences in understandings of people with disabilities and these may provide a basis for and contribute to differences in attitudes of disability.

Conclusions: OT students have established beliefs of disability as individualized or more socially constructed and these influence disability biases.

Significance: Students’ education has considerable influence in shaping attitudes and ways of interacting with people with disability. Understanding students’ assumptions as they enter a program is a first step to evaluate how curriculum design may influence development of student clinical reasoning strategies.     

Feeling like a stranger: negotiations with culture as experienced by Chilean occupational therapists

Background: Although occupational therapy has begun to focus on the subject of culture, few studies have examined how occupational therapists outside the English-speaking countries reflect on it.

Aim: To explore how Chilean occupational therapists reflect on their personal and professional experiences in regard to the complexity of culture, and its different understandings and expressions.

Methods: This qualitative study uses content analysis to establish common trends in participants’ experiences. A validation phase and data triangulation were implemented to ensure trustworthiness.

Results: Culture is experienced as a continuous negotiation in personal and professional terms. One central theme, ‘negotiating through the dynamism of culture’, and three categories, ‘dealing with power’, ‘understanding local and global identities’, and ‘crossing the boundaries into the client’s land’, emerged. These experiences are complex, chaotic, and highly context-dependent.

Discussion: During therapeutic encounters, practitioners and clients may experience cultural barriers even if their differences are not obvious in cultural terms. As a result of this finding, we recommend the inclusion of culture and cultural issues in professional training. The impact of a multicultural research team is discussed. Future research should explore how the construct of culture is introduced in occupational therapy professional training in Chile.     

Sharing the agenda: pondering the politics and practices of occupational therapy research

Abstract

Aims: Occupational therapists espouse a client-centred philosophy of practice, yet little attention has been given to pondering the politics or client-centred practices of occupational therapy research. The aim of this paper is thus to foster reflection on occupational therapy's commitment to client-centredness in the practice of occupational therapy research. Major findings: Occupational therapy research is not consistently undertaken in a collaborative manner. Power resides in control of the research agenda and participants' priorities can be supplanted by those of researchers. However, examples from the literature and from the authors' research suggest that study participants may wish to influence the research agenda such that their needs and priorities are addressed. Practice conclusion: Client-centred principles appear to require occupational therapists to undertake collaborative research and to ensure that research agendas are informed by clients' priorities. Commitment to client-centred principles demands concerted efforts to identify and address potential barriers to meaningful client participation in the occupation of research. However, it is argued that if researchers and disabled people collaborate, and pool their knowledge and expertise, they may achieve research that is more philosophically compatible with espoused professional values; and that collaborative research may also inform more relevant and useful client-centred clinical practices.     

Thinking critically about client-centred practice and occupational possibilities across the life-span

Abstract

Background: Client-centred occupational therapy practice is tacitly guided by prevailing social values and beliefs about what are “normal” occupational possibilities. These values and beliefs privilege some occupations and negate others. Aim: This study aims to identify and problematize assumptions regarding the value of approximating normal occupational possibilities, showing how these assumptions influence and may diminish client-centred practice. Methods: Using empirical research examples it demonstrates how occupational therapists and clients are immersed in contexts that shape values and beliefs about what are considered “normal” occupations and how these taken-for-granted values structure occupational therapy practice. Conclusion: Critique of client-centred practice requires conscious reflexivity, interrogating our own and our clients’ predispositions to value some occupations over others. Engaging in critical reflexivity can help therapists develop new perspectives of how client-centred practice can be applied that includes enabling possibilities for occupations that would be missed altogether in the pursuit of “normal’.     

Relational interaction in occupational therapy: Conversation analysis of positive feedback

Background: The therapeutic relationship is an important factor for good therapy outcomes. The primary mediator of a beneficial therapy relationship is clinician–client interaction. However, few studies identify the observable interactional attributes of good quality relational interactions, e.g. offering the client positive feedback.

Objective: The present paper aims to expand current understanding of relational interaction by analyzing the real-time interactional practices therapists use for offering positive feedback, an important value in occupational therapy.

Methods: The analysis is based on the conversation analysis of 15 video-recorded occupational therapy encounters in psychiatric outpatient clinics.

Results: Two types of positive feedback were identified. In aligning feedback, therapists encouraged and complimented clients’ positive perspectives on their own achievements in adopting certain behaviour, encouraging and supporting their progress. In redirecting feedback, therapists shifted the perspective from clients’ negative experiences to their positive experiences. This shift was interactionally successful if they laid the foundation for the shift in perspective and attuned their expressions to the clients’ emotional states.

Conclusions: Occupational therapists routinely provide their clients with positive feedback. Awareness of the interactional attributes related to positive feedback is critically important for successful relational interaction.     

Perceived occupational balance and well-being among people with mental illness living in two types of supported housing

Abstract

Background: People with psychiatric disabilities often struggle with maintaining a satisfying occupational balance. Knowledge about factors of relevance for occupational balance in this group is therefore vital for improving their support.

Aim: The aim was to describe perceptions of occupational balance among people with psychiatric disabilities living in supported housing (SH) or in own flat/house with housing support (OHS). Potential importance of housing context and socio-demographic, well-being and recovery factors for occupational balance was also explored.

Methods: Participants from SH (N?=?155) and OHS (N?=?111) responded to questionnaires about sociodemographic situation, well-being (self-rated health, life satisfaction and self-mastery), personal recovery and occupational balance (work, leisure, home chores, self-care and general balance assessed by SDO-OB).

Results: A majority in both groups reported being in balance regarding all five domains of occupational balance. The OHS group reported being more under-occupied for home chores and self-care. Self-mastery was the most important contributor in both groups in the domains of work, domestic chores and self-care. Day center attendance was vital for general occupational balance.

Conclusion: Both groups generally perceived occupational balance. Control over one’s life situation and possibilities for regularly participating in occupations outside the home environment should receive high priority in housing support.     

Participatory citizenship: Critical perspectives on client-centred occupational therapy

Abstract

Background/aims: This article aims to discuss client-centred practice, the current dominant approach within occupational therapy, in relation to participatory citizenship. Occupational therapists work within structures and policies that set boundaries on their engagement with clients, while working with complex, multidimensional social realities. Methods: The authors present a critical discussion shaped by their research, including a survey, discussions at workshops at international conferences, and critical engagement with the literature on occupational therapy, occupation, and citizenship. Conclusion: A focus on citizenship suggests reframing professional development based on the participation in public life of people as citizens of their society. While occupational therapists often refer to clients in the context of communities, groups, families, and wider society, the term client-centred practice typically represents a particular view of the individual and may sometimes be too limited in application for a more systemic and societal approach. Significance: The authors question the individual focus which has, until recently, been typical of client-centred occupational therapy. Placing citizenship at the core of intervention is a transformative process that assumes all people are citizens and conceives of health as a collective issue, influencing the way we educate, do research, and practise.     

A review and critique of well-being in occupational therapy and occupational science

Abstract

Scholars in occupational therapy and occupational science often reference well-being when discussing treatment goals or occupational engagement, but the various meanings of this reference remain unexamined in current literature. This paper reports the results of a literature review of five journals and five monographs in the occupational therapy and occupational science literature. The purpose of this review was to understand and critique how scholars in the profession and the discipline conceptualize well-being, guided by broader philosophical perspectives on the subject. The review revealed inconsistent definitions and uses of “well-being” throughout the literature, illuminating the need to reconsider this concept's purpose within the profession and the discipline. Based on these results and building on current theoretical trends, the author advocates a more nuanced and considered use of well-being that acknowledges the uncertainty faced by occupational therapists, occupational scientists, and the people with whom they practice or research.     

The Relationships between Problem-Solving,Creativity, and Job Burnout in Iranian Occupational Therapists

Abstract

Cognitive resources are assumed to have the potential to buffer the negative influence of job demands. In this study, the relationship between burnout, a consequence of job demands, and cognitive resources of problem-solving and creativity was investigated. There were 50 occupational therapists that completed three standardized instruments assessing problem-solving, creativity, and burnout. Using multiple regression analysis and the Independent-Samples t-test to analyze the data, results showed that cognitive resources were inversely associated with burnout [R²?=?0.38, F (4, 45)?=?6.94, p?<?0.001] and comparison analysis showed significant differences in creativity between males and females (p?=?0.04). Significant positive correlations were also found between creativity and working experience whereby higher levels of creativity associated with more working years. Problem-solving and creativity require attention in occupational therapy because they may mitigate against burnout as the consequence of job demands. A possible implication would be the necessity of empowering occupational therapists’ cognitive resources.     

Occupational therapy students’ perceptions of occupational therapy

Background/aims: An understanding of students’ perceptions of occupational therapy on entry is required to recognise how professional socialisation occurs through curriculum. Findings pertain to a qualitative study investigating students’ perceptions of occupational therapy upon entry to two occupational therapy programmes in Australia. Methods: Students commencing Bachelor of Occupational Therapy and Masters of Occupational Therapy Studies programmes participated in the study (n = 462). A purpose‐designed questionnaire was distributed to students in the first lecture of each programme. Preliminary analysis comprised identification of keywords/phrases and coding categories were generated from patterns of keywords. Frequency counts and percentages of keywords/phrases within categories were completed. Results: Students’ responses were categorised as ‘what’ occupational therapists do; ‘how’ they do it; ‘why’ they do it; and ‘who’ they work with. In ‘what’ occupational therapists do students frequently described ‘helping’ people. Both undergraduate and graduate entry masters students used the term ‘rehabilitation’ to describe how occupational therapy is done, with graduate entry students occasionally responding with ‘through occupation’ and ‘modifying the environment’. Students perceived the ‘why’ of occupational therapy as getting back to ‘everyday activities’, with some students emphasising returning to ‘normal’ activities or life. Regarding the ‘who’ category, students also thought occupational therapists worked with people with an ‘injury’ or ‘disability’. Conclusions: Students entered their occupational therapy programmes with perceptions consistent with the general public’s views of occupational therapy. However, graduate entry students exposed to a pre‐reading package prior to entry had more advanced occupational therapy concepts than undergraduate students.     

Client-centred occupational therapy with children: A critical perspective

Abstract

Background: Client-centredness is a central theme within occupational therapy; however, its application within clinical practice has not been thoroughly examined within the literature. Aim: The aim of this practice reflection is to provide a critical perspective on client-centredness in occupational therapy practice with children. Methods: Two action points of the Canadian Practice Process Framework (CPPF): Set the Stage and Agree on Objectives and Plan are applied to examine the concept of client-centred practice using a common practice example. Results: There are multiple benefits to using a client-centred approach to goal setting and developing a therapy plan. Practical challenges to client-centred practice include a lack of time, organizational support, and professional autonomy. Therapists may exert power over clients by enforcing institutional policies that prioritize the client diagnosis and organizational processes. Conclusion: The authors support a client-centred approach to occupational therapy practice with children but suggest that therapists may feel conflicted in trying to apply these principles within the current context of rehabilitation for children. Occupational therapists are encouraged to identify opportunities where they can advocate for a client-centred approach to services.     

“My view that disability is okay sometimes clashes”: experiences of two disabled occupational therapists

Abstract

Aims: While disability is the focus of much attention in occupational therapy, there has been little attention paid to disability within the profession. Disabled therapists not only bring valuable perspectives on disability, but also pose important challenges to taken-for-granted assumptions about impairment and disability within the profession. At the same time, their cultural beliefs and values may clash with core assumptions of the profession. Methods: This study analyses interview data from two disabled occupational therapists, part of a larger study with cultural minority therapists. Semi-structured interviews explored their experiences of professional practice in the context of societal belief in the superiority of non-disabled and “normal” ways of doing and being. Major findings: Some cultural values of participants clashed with the values and beliefs of their profession, particularly concerning independence. Negative attitudes of colleagues and managers were the key barriers to practice. The responsibility for bridging the disabled/non-disabled cultural divide rested with the disabled therapists, exacerbating inequity. Nonetheless, these therapists believed their disability experiences had advantages for practice. Conclusions: Disabled therapists may be required to engage in invisible work to communicate across cultural differences, and to educate others. Respectful openness to difference could enhance the practice competence of both disabled therapists and their non-disabled colleagues. This demands critical reflexive attention to ableism within the profession.     

A survey on client-centered practice among danish occupational therapists

Background: In Denmark, the cost of healthcare services comprise 12% of the gross domestic product. A recommended method for optimizing effectiveness of and enhance client satisfaction with healthcare is client-centred practice (CCP), a central component of occupational therapy ideology. However, Danish occupational therapists’ perceptions of CCP, including the facilitators and barriers that may contribute to CCP, have never been examined.

Aim: To examine Danish occupational therapists’ perceptions of CCP.

Methods: A survey was conducted using an electronic questionnaire in a small, but representative sample of Danish occupational therapists from all regions and practices.

Results: Three hundred and forty-six occupational therapists (5%) responded. Of these, 98% rated CCP as important, 97% considered their work client-centred, and 92% were satisfied with their level of CCP. Having time to conduct self-directed work, using assessments to identify clients’ priorities, and CCP education, but not fixed regimes, were positively correlated with CCP.

Conclusion: Danish occupational therapists perceive to practice CCP and appear to have adopted the beliefs, theory and ideals of CCP, perhaps influenced by the egalitarian Danish culture. Self-directed work, means to identify and evaluate their clients’ wishes, and education facilitated CCP. Possible absence of occupational therapists not compliant with CCP makes further research warranted.     

Development and content validity of the Norwegian Self-Assessment of Modes Questionnaire (N-SAMQ)

Background: The Intentional Relationship Model (IRM) introduced six therapeutic modes as ways of relating to clients. By increasing occupational therapists’ awareness of modes, and by increasing their skills in using them, therapists may improve their interactions with clients. The Self-Assessment of Modes Questionnaire may assist in increasing awareness of modes. Aim: To describe the process of developing a Norwegian version of the Self-Assessment of Modes Questionnaire (N-SAMQ) and to evaluate its content validity. Materials and methods: A 10-step translation and adaptation procedure was followed. Occupational therapists working in diverse practice areas completed the preliminary N-SAMQ version. Individual cognitive interviews were performed with these therapists in order to examine the comprehensibility and cultural appropriateness of the N-SAMQ. Results: Initially, one item was omitted. Following the pilot study (n?=?7), two of the remaining items were modified with a view to increasing their cultural relevance. Otherwise, modifications were made mostly in terms of words and phrasing. Conclusion: The N-SAMQ appears to have good face and content validity. Significance: With the N-SAMQ, Norwegian occupational therapists can assess their preferred therapeutic modes.     

Client-centred practice in occupational therapy: Critical reflections

Abstract

Aims: The occupational therapy profession has long proclaimed its commitment to a client-centred philosophy of practice and the assumption that occupational therapists consistently practice in a client-centred manner has become central to the profession's self-image and public rhetoric. However, client-centred practice has been subjected to little critical reflection within the occupational therapy profession. The aim of this paper is to foster critical reflection concerning the authenticity and veracity of the profession's commitment to client-centred practices. Major findings: Client-centred practice is defined without evident reference to clients' perspectives. Few occupational therapy researchers have sought clients' perceptions of the client-centred nature of their occupational therapy services. Occupational therapy research is neither consistently undertaken in a collaborative manner, nor are the profession's theories developed through explicit reference to a diversity of clients' perspectives. Professional practices and service evaluations do not consistently seek clients' viewpoints. Client-centred rhetoric is politically expedient and may be a professionalizing strategy employed to increase status and entrench power. Practice conclusion: Although exemplary client-centred occupational therapy practices exist, evidence suggests that the profession does not adhere consistently to its espoused client-centred principle in all its practices. The client-centred practice of occupational therapy should be subjected to assiduous critical reflection.